Surgical suture



C-. T. DAVIS SURGICAL SUTUBE. APPLICATION FILED MAR-1711920 Patented June 28, 1921.

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UNITED STATES PATENT OFFICE.

- CHARLES 'r. DAVIS, or NEW YORK,- N. Y.

SURGICAL sururm.

Application filed March 1%, 1920. Serial No. 366,570.

To all whom it may concern:

Be it known that 1, CHARLES T. DAVIS, a citizen of'the United States, and resident of New'York city, in the county of Kings and 5 State of' New York, have invented certain new and useful Improvements in Surgical Sutures, of which the following is a 'speclfication.

invention relates to surgery and is especially directed to improvements in surg1- cal ligatures or sutures.

Standard surgical sutures are manufactured in .a great variety of materials and sizes generally packaged in. sealed glass tubeseach containing a coiled suture immersed in a preserving or storing fluid. Each, tube ordinarily carries a label of some kind for identifying the kind, size, absorption time or other characteristics of the particular suture therein, permitting the surgeon to select sutures adapted to the particular operation which is contemplated. In order to facilitate sterilization of the suture tubes by boiling, the labels are fre-,

quently placed within the tubes, where they are more or less hard to read, rendering mistakes possible. Furthermore, in the operating room it'is common practice to have an assistant remove the suture from its tube,

thread it through a needle and hand it to the surgeon at the proper moment; and

when this procedure is followed, it is impossible for the surgeon 'to be certain that the correct suture is presented to him, so he must rely entirely upon the care of his assistant. Mistakes in the selection of proper sutures are particularly likely to occur as between sutures having different absorption periods. Such sutures are substantially identical in appearance, the label affording the danger of employing a suture of short absorption periods in place of one having a long period will be readily appreciated.

One of the two main objects of my invention is to eliminate the danger of such mistakes by providing means for identifying each type ofsuture directly by imparting to it a characteristic color. This object includes the employment of a suitable color scale or scheme comprising a series of distinctive colors, each of which is applied to and identifies a suture having certain characteristlcs as to material, s1ze, absorpt1on period, or other qualities, according to a ,prearra1iged scheme. With such "an arrangement, the nature of each suture can be ascertained at a glance by its color regardless of any label, and after the suture has been withdrawn from its container.

. A further object is to provide a series of dyes adapted to impart to the sutures the deslred characteristic colors, and which will be free from harmful effect both upon the sutures and upon the tissues with which they come in contact during use.

I also provide a series of characteristically dyed sutures which can be sterilized by heat and otherwise treated in the usual way without materially affecting either the dye or the suture.

As has been noted, it is customary to keep sutures immersed in a preserving fluid until they are needed for use. One object of this phase of my invention is to provide a series of characteristically dyed sutures which maybe immersed in the usual preserving fluids without affecting the dyes, su-

turesor fluid, the dyes preferably being in-' soluble in such fluids.

Another feature of my invention is the provision of a convenient package for surgical sutures which are characteristically dyed, the package bearing alegend serving as a guide to the characteristics of the sutures identified by the various distinctive colors.

Ordinary uncolored sutures have a relatively light color ranging froma' light yellowish brown to white, many being also translucent. the sutures diflicult to discern against the tissues through which, they are passed insewing-a wound, necessitating the use of a much larger suture than is required by the strain to which the suture will be subjected. One object of this phase of my invention is to provide sutures characteristically colored which will be easily discernible against the tissues, permitting the employment of fine sutures and diminishing the size of the suture track, thus reducing injury to the tissues of the body.

Another difficulty encountered in the employment of the usual sutures is the danger of carrying infection into the wound with the suture. While the greatest care is taken to sterilize sutures, they are quite likely in actualuse to carry bacteria into the suture track from the skin of the patient or other infected areas through which they pass. Furthermore, while the need for This natural coloring renders.

absolute sterility of all objects and materials employed in connection with operations is universally recognized, yet the exigencies and emergencies ofan operation are likely to disturb the carefully planned routine, especially when a substantial part thereof isperformed by assistants and nurses, who mav be forgetful or confused. Consequently, it has been found that the employment of sutures which are sterile when taken from their tubes is insufficient to prevent infection of the suture track, owing to the danger of contamination thereof by care less handling after removal, or from infected parts of the subject.

It has been sought heretofore to avoid this difficulty by impregnating sutures with iodin, which is intended to act'as an antiseptic to prevent infection from the suture. This practice, however, is open to several objections. In the. first place, the germicidal effect of iodin has. been overestimated, ex-

periments showing that in three to four hours after using an iodin-impregnated suture the iodin hasentirely disappeared both from the suture and from the surrounding tissue.

employed. Even without' the, application of heat, it has been found thatiodin tends to weaken sutures to which it is applied. 7

The second principalobj-ect of my invention, therefore, is to avoid these difficulties by providing a suture which is colored with an antiseptic substance, as by impregnating it with an antiseptic dye. With this phase of my invention, the dye may also be used for the additional purpose of imparting a color which will permit the suture to be readily discerned against the tissues. The employment of finer sutures rendered possible by this means not only reduces the necessary laceration of tissues incident to sewing or suturing them; but also permits much more'rapid sewing, a point of major importance in operating. Furthermore, the cicatrice is substantially reduced, a result which is greatly desired by patients.

A f,urther object is to provide such an antiseptic dye which will have no harmful effect on the suture or its preserving fluid, and which can be heated in the usual sterilizing process without affecting the suture. I also preferably employ an antiseptic having much greater perslstence and strength than 1 am and which in its, preferred form is adapted to penetrate the that dyes of this kind have no harmful effect whatever upon sutureor ligature filament made of the various kinds of material generally employed there-for, such as catgut,

kangaroo tendons, silkworm gut horse hair, silk, thread and similar substances. Such dyes do not-weaken sutures to which they are applied, but in some cases have a strengthening effect thereon. Furthermore, they are unaffected by moderate heat or light, permitting the sutures to be, sterilized,

by heat in the usual way; and moreover,

such coal-tar dyes have no effect on the usual storing fluids, being insoluble in such fluids as toluol and xylol. Coal-tar dyes afford an almost unlimited range of colors, including many distinctive dark shades particularly suitable for rendering sutures conspicuous against the tissues in which they are embedded. Moreover, certain coal-tar dyes are highly antiseptic, being much more power ful and persistent than iodin while lacking the undesirable features of that element as indicated.

It has been found by experiment that coaltar dyes from all of the well-recognized groups of such dyes are suitable for use in coloring sutures. Examples of such dyes are those generally known as Martius yellow,

crystal violet 6 B, rhodamin B, acrifiavin,-

methylene blue, scarlet 4 R, acid yellow A. T., fast green, orange R. R, indigo carmine, mercurochrome-220, thiofiavin, ni-

grosin and phosphene. Furthermore, a large number of such dyes arereadily soluble in water, and when suture materials are soaked in water solutions of such dyes, they readily take the dye, and do not give it up in such storing fluids as toluol or xylol. Coal-tar dyes may be applied to suture materials by this or any other well-known method, and

where the antiseptic or germicidal action of the dye is not a primary requisite, any

standard chemical mordant, such as a watery solution of tannin,may be used.

Inattaining my first object, that of identifying each suture, by applying thereto a coal-tar dye of a characteristic color, it'

will be apparent that the sutures ma be classified in various ways on the basis 0 one or a combination of their different. characteristics, such as material, size,.or absorption period. According to my invention, a

distinctive coal-tar dye is applied to each separately classified suture, the wide color range of such dyes permitting an extensiveclassification if desired, without undue similarity of colors. Furthermore, the dyes may...

includes essentially a series of characteriscordance wlth the suture classification. em-.

be arranged systematically as to color, inacployed, providing what may betermed a chromatic scale, and facilitating ready identification of a relatively large number of suture classes. I

A convenient method of characteristicallycolored sutures and a suitable package therefor is illustrated in the accompanying drawings, in which:

Figure 1 is a front view, parts belng broken away, and

Fig. 2 is a transverse sectional View.

The package shown in the drawings is constructed in accordance with the disclo-.

sure of my Patent 1,121,232, and includes in eneral an outer container or box 11 preferably of the telescoping type, and a suitable socket forming member therein, such as the corrugated board insert 12. Each suture 13 shown in the form of a coiled filament is packaged in the usual sealed glass tube 14, which fits into a socket in member 12, the container being adapted to hold a number of tubes 14. Each of the sutures 13 is dyed a characteristic color, it being immaterial whether all the sutures in a pack age are of the samecolor, or whether each package contains sutures of diiferent colors.

f desired, each tube may carry a label 15 either inside or outside of the tube, bearing suitable information regarding the nature of the suture.

Upon the container 11, and preferably upon a label on the outside thereof, may be mounted a suitable legend designating the suture characteristics indicated by each color. Various forms of legend may obviously be employed, including mere printed tabulation or recital of each color and the suture characteristics corresponding thereto. If desired, however, the portion of the legend relating to each color maybe printed in rsuchcolor, or a suitable area of such color. may be placed in juxtaposition to the printed legend to indicate graphically the color of the suture having the indicated characteristics, this arrangement being particularly advantageous where a relatively large number of colors is employed, thus avoiding any ambiguity in the descriptive terms applied to similar colors.

An example of a legend of this type whichmay be called a chromatic scale, is shown in Fig. .1, in which a series of consecutively arranged suitably colored areas 16 are each placed in juxtaposition to printed indicia which may include a description of the color 17, and should include a statement of the suture characteristics 18, the examples given relating to catgut sutures of various absorption periods. It is obvious,

arranging the however,thata;great many variations in the type of legend are possible, and the specific "show ng is primarily illustrative.

,It'will also be obvious that the package tically coloreds'utures and a' suitable legend indicating the color scheme,'and that these "features may be embodied'in a very large 1 variety of packages, both as to the innersu- 1 ture containers 14, the outer container 11,

-my invention limited to the use of such a color scale to indicate variations in all of the properties of sutures, as such scale may be limited to some one feature of thesutures, such as their absorption period or their material. For instance, plain catgut might be stained yellow, as with acriflavin; 10-day chromic catgut could be stained green, as with brilliant green; 20-day chromiccatgut, black, as with nigrosin; and 40-day chromic catgut, violet, as with crystal. violet 6 B. Even with such a limited application of my invention, the ever-present danger of mistakes in the absorption period of the suture employed at the operating table would be eliminated, as each type would be distinguished at a glance by the surgeon, even after it had been removed from its original tube and label. u I also attain my second object, that of rendering sutures antiseptic, by impregnating such sutures with coal-tar dyes. Scientific investigation has established the'fact that many coal-tar dyes possess distinct germicidal properties, certain of these dyes having a very powerful antiseptic effec. Some of the better known examples of this 0 type aremercuro'chrome-QQO, gentian violet, crystal violet and brilliant green, together with dyes of the acridine group generally known commercially as fiavin antiseptics.

Antiseptic dyes of this character possess, in common with the other coal-tar dyes, the above outlined advantages of ready application to standard suture materials and the absence of any harmful effect thereon. Moreover, they are free'from the objections to iodin above noted. In'addition to such advantages, these dyes possess antiseptic properties, rendering them peculiarly adapted for use in sutures. Forv instance, they are especially effective in penetrating the 'tissues about the suture track, producing .asepsis throughout a relatively extensive not only facilitating their application to sutures and preventing their dissipation in the usual storing fluids, but also enabling them to permeate the tissues of the body in which the suture is embedded by difiusion through the water which normally permeates such tissues. Moreover, while such antiseptic dyes are not irritating to the tissues of the body and are not poisonous when used as indicatedherein, certain of these dyes, such as acriflavin, proflavin, mercurochrome-220,

gentian violet, etc. are more effective antiseptics than iodin, even when employed in very high dilutions. v

A further advantage common to coal-tar dyes is the fact .that mercury or iodin atoms may be substituted for certain of the atoms in each of such dyes,-producing what are known as mercury and iodin substitution products of the coal-tar dyes. It has been found that these substitution products-possess distinct antiseptic qualities while retaining the advantages for use in sutures which have been hereinbefore outlined. While iodin is objectionable in its free state as a germicide forsutures, it has been found that the objections thereto do, not apply to the iodin substitution products of the coaltar dyes, but that such substitution products possess a greatly increased antiseptic effect. The mercury substitution products also have marked germicidal properties, which have been particularly investigated and demonstrated in connection with derivatives of the fluoresceine group,- one example being mercurochrome-220. g

The methods of applying the coal-tar dyes to substances which are to be dyed therewith are well-known, and any of such methods may be employed in applying the dyes to the suture material. Furthermore, any amount of dye which will be taken up by such material may be employed, though I have found that a relatively small quantity is sufficient to produce both the coloring effect and to possess the desired germicidal strength. One method which may be used includes the soaking of suture material in a watery solution of the dye, which preferably 'does not exceed 1% in concentration, it being understood that other solvents, such as weak soda solutions among others, may be employed, the proper solvents for the various 'dyes being well-known to those skilled in the art. When the suture materials are thoroughly impregnated with the dye, they are taken out of the. solution, and any surplus dye removed as by quick washing. If a watery solution has been employed, the water remaining in the suture material is removed by any suitable dehydration process,

such as the application of heat. The dyed,

suture is then coiled, placed in a glass tube,

a suitable storing fluid, such as toluol or tively investigated and are well-known to I those skilled in the art, I have not considered it necessary to indicate the various dyes which possess certain of such characteristics set forth in this specification, such as solubility in wateror other specific fluids. It

is also to be understood that, while I have mentioned certain. dyes as possessing an especial antiseptic value, my invention is not limited to such dyes, to other dyes of the same general nature, nor even to dyes or their derivatives which at present are known to possess germicidal properties; since my invention does not consist in-the discovery thatcertain dyes do or do not possess such properties, but in one phase thereof consists in the employment of such germicidal coaltar dyes and their derivatives to render sutures antiseptic. As I am fully aware that many coal-tar dyes are suitable for use in sutures without impairing the efiicacy of the sutures or interfering with the normal handling thereof, and as the determination of the germicidal effect of. any dye does not require lnvention butmerely the application of wellknown scientificmethods, I consider my invention to include the employment in sutures of any coal-tar dye which may by future investigation he identified as having antiseptic properties.

While I have mentioned thesubstitution of mercury and iodin in the. coal-tar dyes, it will be apparent that other chemical elements-or groups of elements, such as other halogens, other metals, or other chemical radicals, may-be employed. instead of iodin;

usually gives its name to the class. Further,

more, substitution products in the different classes are well recognized. Consequently, I prefer to employ in the claims the term coal-tar dyes as embracing not only the parent dye of each class, but the derivatives and substitution products thereof, as set forth herein.

It will be understood that while I have used the term suture, as covering broadly theclass of sewing or binding filaments employed in surgery, my invention is equally applicable to the suture materials prior to manufacture thereof into sutures.

I claim:

1. The combination of a surgical suture and a coal tar pre aration rendering the same antiseptic and yeing the same a defining color. I v w 2. A filament and a coal'tardye impregnating the same and forming a colored surgical suture having antiseptic qualities.

3. A filament of a material capable of absorption, and a coal tar d-ye impregnating and identifying the same and providing antise tic qualities.

4. he combination ofi a filament and a dye impregnating, the same, forming a colore'd surgical suture providing antiseptic qualities,

5. "The combination with a systematically arranged 'seriesof' sutures difierin in characteristics, of means carried by said sutures for identifying a characteristic of each suture, said means including a plurality of dyeshaving antiseptic qualities and differing in color, each dye being applied to one ofthe sutures to render the same antiseptic and impart thereto a characteristic color as comparedwith the other sutures of the series.

6. The combination with-a systematically arranged series'of-sutures difierin in characteristics, of means carried by said sutures for identifying a characteristic. of' each suture, said means including a plurality of coal tar dyes having antiseptic qualities difhaving antiseptic qualities and. differing in color, each dye being applied only to a suture having a fixed predetermined absorption period, the arrangement'being such that the absorption period ofeach suture. in the series is readily distinguishable'by' the color i1 n parted thereto by the coal tar dye.

8. A package for surgical sutures, includ-- ing a suture impregnated with an antiseptic dye, and a contalner therefor bearing a legend, indicatingthe nature of the suture 15y reference to the color'ofthe impregnated 9. A package for surgical sutures, including a plurality of inner containers, sutures therein impregnated with characteristically colored dyes. having antiseptic qualities, and

an outer'container bearing a legend, indieating the nature of each suture by reference to the color of the dye'impregn'ated therein.

Signed at'NewYork citly, in the county of Kings and State of New ork'this 17th day of February,-A. D. 1920.

CHARLES T. DAVIS. 

